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Hemispherectomy for the Control of Intractable Epilepsy in Childhood: Comparison of 2 Surgical Techniques in a Single Institution

Kwan, Allison HBMSc1; Ng, Wai Hoe MBBS, FRACS2; Otsubo, Hiroshi MD1; Ochi, Ayako MD1; Snead, O Carter III MD1; Tamber, Mandeep S MD, PhD, FRCSC1; Rutka, James T MD, PhD1

Neurosurgery:
doi: 10.1227/NEU.0b013e3181f743dc
Operative Technique: Editor's Choice
Abstract

BACKGROUND: Hemispherectomy is an established neurosurgical procedure for catastrophic epilepsy in childhood. However, the technique used to achieve an optimum outcome remains to be determined.

OBJECTIVE: We examined the influence of hemidecortication (HD) vs peri-insular hemispherotomy (PIH) on patient outcome.

METHODS: The medical records of 41 children undergoing hemispherectomy were reviewed for patient demographics, clinical criteria, and surgical outcomes.

RESULTS: HD and PIH were performed in 21 and 20 children, respectively. The mean age at surgery for HD was 54 months and 61 months for PIH. The median durations of surgery for HD and PIH were 5 hours and 7 hours, respectively (P < .001). For HD, 6 patients required a second surgery and 3 required a third. One PIH patient required a second procedure. Postoperative shunting was required in 5 HD patients, but only 1 PIH patient. All patients had increased hemiparesis after surgery. The overall mean follow-up time was 72 months. Engel class I or II outcomes after initial surgery were better after PIH (85%) compared with HD (48%) (P < .02). After subsequent surgeries for seizure control, 4 HD patients and 1 PIH patient improved to Engel class I or II.

CONCLUSION: Hemispherectomy is an effective surgical procedure for childhood intractable catastrophic epilepsy. In patients with diffuse hemispheric disorder, PIH tends to have fewer major complications, more favorable seizure outcomes, and a decreased need for subsequent surgical procedures, including shunting for hydrocephalus, compared with HD.

Author Information

1Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

2Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Department of Neurosurgery, National Neuroscience Institute, Singapore

Received, September 2, 2009.

Accepted, May 26, 2010.

Reprint requests: James T. Rutka, MD, PhD, Division of Neurosurgery, Suite 1503, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. E-mail: james.rutka@sickkids.ca

Copyright © by the Congress of Neurological Surgeons